摘要
目的探讨肠梗阻导管经由自然孔道行小肠排列治疗粘连性小肠梗阻和预防梗阻复发的适应证、方法和疗效。方法 2007年7月至2011年9月,共纳入需手术治疗的粘连性肠梗阻患者21例。术前诊断:肠粘连松解术后15例,宫外孕术后1例,直肠Dixon术后1例,先天性小肠旋转不良1例,腹茧症1例,阑尾穿孔切除术后2例。手术方式:肠粘连松解术9例,肠粘连松解+小肠部分切除术10例,肠粘连松解术及横结肠造口术1例,末端回肠造口术1例。术中同时置入肠梗阻导管经鼻行小肠内排列,术中引导至末端回肠。患者常规治疗包括:禁食、纠正水电解质和酸碱失衡、营养治疗,支持治疗等。结果术中成功置管20例粘连性小肠梗阻患者,1例置管未成功。平均置管时间(15±9)min。平均胃肠减压量为:(502±114)ml/d;全组患者术后平均(4.4±3.2)d排气,术后(6.2±2.2)d开始带管进流食。术后平均(14.7±7.6)d拔管,术后均顺利拔管。置管期间并发症发生率15.0%(3/20):2例切口感染;1例鼻咽炎。术后随访20例5～40个月,2例(10.0%)在术后6个月内出现间断腹胀,经对症治疗后缓解。治愈率为90.0%,无因肠梗阻而再手术病例。结论在肠粘连松解和肠切除的基础上,应用肠梗阻导管进行小肠内排列术,操作简单,微创,疗效可靠。可明显改善粘连性肠梗阻患者症状,降低肠梗阻的复发率。在严格掌握适应证的前提下,可作为小肠内排列的选择术式之一。
Objective To investigate the indications and application of ileus tube in intestinal plication for adhesive intestinal obstruction,and to improve the clinical outcomes.Methods We reviewed the medical records of 21 patients with adhesive intestinal obstruction,who had undergone intestinal plication using the ileus tube from July 2007 to September 2011.The patients included 15 patients with enterolysis,1 with ectopic pregnancy,1 with Dixon＇s surgery,1 with congenital malrotation of the intestine,1 with abdominal cocoon,and 2 with appendiceal perforation.Operations included intestinal adhesion lysis in 9 patients,intestinal adhesion lysis ＋ partial small bowel resection in 10,intestinal adhesion lysis and transverse colostomy in 1,ileostomy in 1.The ileus tube was placed into a small intestine through the nose,reaching the terminal ileum.The patients received conventional treatments including fasting and total parenteral nutrition support to keep water-electrolyte and acid-base balance.Results Intestinal plication was successful in 20 patients and one patient failed for insertion.The average time of insertion and plication was（15±9） min.The average amount of gastrointestinal decompression was（502±114） ml/d.The length of time for passage of flatus was（4.4±3.2） d;the time to liquid diet was（6.2±2.2） d.was（15±9） min.The average amount of gastrointestinal decompression was（502±114） ml/d.The length of time for passage of flatus was（4.4±3.2） d;the time to liquid diet was（6.2±2.2） d.The average time to remove ileus tube was（14.7±7.6） d.The ileus tube was successfully removed in all patients.The incidence of complications during treatment was 15.0%（3/20）,including wound infection in 2 patients and nasopharyngitis in1 patient.The time of postoperative follow-up for 20 patients was 5-40 months.Two patients（10.0%） had intermittent abdominal distention within 6 months after the surgery and were treated conservatively,with a cure rate of 90.0%.Conclusions Intestinal plication is feasible and reliable in the management of patients with adhesive intestinal obstruction;however strict indications should be followed.
出处
《中华普外科手术学杂志（电子版）》
2012年第4期24-26,共3页
Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)
关键词
肠梗阻
消化系统外科手术
肠排列术
Intestinal obstruction
Digestive system surgical procedures
Ileus tube
